Kasbohm Elisa, Chenot Jean-François, Schmidt Carsten Oliver, Truthmann Julia
Department SHIP-KEF, Institute for Community Medicine, University Medicine Greifswald, 17475, Greifswald, Germany.
Department of General Practice, Institute for Community Medicine, University Medicine Greifswald, 17475, Greifswald, Germany.
BMC Musculoskelet Disord. 2025 Apr 3;26(1):330. doi: 10.1186/s12891-025-08514-1.
Claims data are often used to investigate the quality of care for patients with low back pain (LBP). However, there is no standard regarding the preferred choice of ICD-10 codes for identifying patients with LBP, and guidelines for the treatment of LBP differ in their interpretation of ICD-10 codes. Furthermore, for some indicators measuring the quality of care, such as the appropriate use of imaging, it is necessary to differentiate between cases with specific, treatable causes and those without. This study therefore investigates coding practices for LBP in outpatient care and the use of imaging across specialist groups over a six-year period.
Based on the TREND cohort of the population-based Study of Health in Pomerania (SHIP), coding practices in claims data were analysed using data from 3,837 statutorily insured participants for the years 2014-2019. In total, eleven ICD-10 categories of relevance to LBP were included. We evaluated the findings based on two German guidelines: one for specific and one for non-specific LBP.
At least one LBP diagnosis was coded for 2,474 participants (64%) during the entire observation period. The predominant ICD-10 category was M54 (dorsalgia, 87% of patients with LBP). Around half of the participants with M54 diagnoses also had diagnoses from other LBP-related categories in the same year. Diagnoses that can be assigned to specific LBP according to the respective German guideline occurred in 86% of patients with LBP. Participants who consulted only general practitioners during the observation period were more likely to receive only an M54 diagnosis and less likely to undergo imaging procedures.
The results underline the high epidemiologic relevance of LBP. Using the German guideline on specific LBP as a reference, we categorized most LBP diagnoses as specific, contrary to common international assumptions. Most patients with LBP received multiple ICD-10 codes, complicating the distinction between non-specific and specific LBP based on claims data. Health care analyses on LBP require transparent reporting of the ICD codes used, along with a detailed discussion of the data's limitations.
索赔数据常被用于调查腰痛（LBP）患者的医疗质量。然而，在用于识别LBP患者的ICD - 10编码的首选选择上没有标准，并且LBP治疗指南对ICD - 10编码的解释也有所不同。此外，对于一些衡量医疗质量的指标，如影像学的合理使用，有必要区分有特定可治疗病因的病例和无此类病因的病例。因此，本研究调查了六年期间门诊护理中LBP的编码实践以及各专科组影像学的使用情况。
基于波美拉尼亚州基于人群的健康研究（SHIP）的TREND队列，利用2014 - 2019年3837名法定参保参与者的数据，对索赔数据中的编码实践进行了分析。总共纳入了与LBP相关的11个ICD - 10类别。我们根据两项德国指南评估了研究结果：一项针对特定LBP，另一项针对非特定LBP。
在整个观察期内，2474名参与者（64%）至少有一次LBP诊断被编码。主要的ICD - 10类别是M54（背痛，占LBP患者的87%）。同年，约一半被诊断为M54的参与者也有来自其他LBP相关类别的诊断。根据相应德国指南可归类为特定LBP的诊断出现在86%的LBP患者中。在观察期内仅咨询全科医生的参与者更有可能仅获得M54诊断，且接受影像学检查的可能性较小。
结果强调了LBP的高流行病学相关性。以德国关于特定LBP的指南为参考，与常见的国际假设相反，我们将大多数LBP诊断归类为特定类型。大多数LBP患者有多个ICD - 10编码，这使得基于索赔数据区分非特定LBP和特定LBP变得复杂。关于LBP的医疗保健分析需要透明报告所使用的ICD编码，并详细讨论数据的局限性。
